Perilous Intersection

The Hospitalist. 2009 January;2009(01):

January 1, 2009|The Hospitalist

When Amsterdam Airport Schiphol in the Netherlands revamped its men’s restrooms, the architects installed small, Euro-style urinals: a surefire way to throw urine off target. To solve this problem, the black outline of a fly was etched in the porcelain near each urinal’s drain. Users’ aim improved and spillage was reduced by 80%. “They try to power blast it away,” says Sanjay Saint, MD, hospitalist and professor of internal medicine at the Ann Arbor VA Medical Center, University of Michigan. “By the time they might realize that the fly isn’t going anywhere, the men are done and walking away.”

It’s a guy thing, sure. It also is an example of a human factors intervention. “Science teaches us that implementing a design for a machine or device that elicits an instinctive reaction from someone using it is a clear-cut way to avoid error,” Dr. Saint explains.

What It Is and Why It’s Important

Human factors (HF), or human factors engineering (HFE), also sometimes called usability engineering or systems-based practice, refers to the study of human abilities and characteristics as they affect the design and smooth operation of equipment, systems, and jobs.1 HF is the basic science underlying much of patient safety practice. For instance, the current recommendation that hospitals standardize equipment, such as ventilators, programmable IV pumps, and defibrillators, is an example of making tasks human friendly. The use of cognitive psychology and biomechanics to develop and improve software and hand tools are another example of HF principles.

To sum up the essence of Dr. Nagamine’s project, she invokes her favorite quotation from systems expert James Reason: “We can’t change the human condition, but we can change the conditions under which humans work.”

In general, HF examines the component tasks of an activity in terms of three factorial domains: physical and environmental factors, cognitive factors (skill demands and mental workload), and organizational factors. Each task is assessed in terms of necessary interactions of the individual and work environment, the device/system design, and associated team dynamics.

HF use in healthcare is not new; for roughly four decades HF researchers have emphasized the key role of HF in safe medical design, healthcare facility operations, and patient safety processes. HF helps organizations deepen analyses of adverse events and develop effective solutions.2 HF is used in the design of labeling, warnings or alarms, software programs, information displays, paper forms, process and activity flow, workplace design, cognitive aids, decision support systems, and policies and protocols.

Human Factors in Hospital Medicine

As the area medical officer with the Schumacher Group’s hospital medicine division in Lafayette, La., David Grace, MD, considered human factors when tweaking designs of simple paper or software templates. His sense of what human factors encompasses prompted him to address some cognitive pitfalls to help prevent error and oversight on standardized “old-fashioned paper” progress notes. “While most docs know how to take care of patients and what patients need given an acute condition,” he says, “in the heat of battle, little things get overlooked. I created little prompts to remind docs what every patient needs.”

Dr. Grace also realized as hospitalists reviewed patient charts, their mindset was typically looking for problems, things like unstable vital signs. Yet, by the time they return to their notes, hospitalists on occasion forget things. “Now, at the top of the progress notes, we have a box marked Problem List, with a space for jotting them down as they go,” he explains. Dr. Grace says as a result of the new checklist, he directly associates an increase in patient satisfaction rates.

He also tackled standardizing reminders for important care procedures. “We all know DVT prophylaxis needs to be done, but it’s easy to overlook when considering the patient’s other problems,” Dr. Grace says. The group’s medical record software template has a single mouse-click to indicate the bundle has been initiated. “Our compliance with DVT prophylaxis has increased dramatically,” he says.—AS